Am I? I think I am.

This week has been, as I suspected it would be, utterly crazy. Pregnancy tests suck! I hate them, I hate them, I hate them. Ahhh....that's better.  

I didn't wait until Friday to test; I didn't make it until Thursday or even Wednesday. By the time Monday turned up I was already clinging on to the last shreds of my very fragile mind. I didn't want to break but how could I resist? I needed to know. The agony of being so close to pregnancy was driving me insane, really it was climbing the walls time; it was also torturing my husband. We went back and forth. Shall we? No let's not. It won't hurt. No we can't. Eventually, on Tuesday, we flipped a coin. Heads I test, tails I don't. The coin spun in the air, landed on my hand and I peeked. Tails! Arrggghhh. Not tails, surely!?! That was it. Our will was broken.


I unwrapped that first magic stick and let the urine flow. Had I drunk too much? Not enough? Was it too early? Should I wait to use my morning wee? Too late, the stick was soaked. Placing the test face down on our dining room table, we waited. Three agonising minutes passed. We couldn't look, we held each other and then we saw this:

It wasn't the darkest line in the world but, look, there's definitely a second line.


We went to bed happy. Oh so very happy. My mind was filled with bliss, until the next morning when I decided, as you do, that one test wasn't enough to keep me going and I got slapped round the face with this little beast:

 

 

Yes, you're right, the second line has vanished. What on earth did that mean? Was I pregnant or not?

 

 

Life was not fun that day. The birds weren't singing and the sun didn't shine. I couldn't wait to get home and pee, and pee I most certainly did; this is what we saw:

 

 

 

 

 

Yipee! Oh, do pardon the pee pun. The second line returned. We could be happy again. We chatted joyfully about how it would finally be our turn for a little one. Until, of course, I lost my shit and went for another test and then, because I am a lunatic, another. I don't know how anyone stops at one. Good Lord, I admire you solo testers. To me pregnancy tests have the same allure as heroine does to the most drug addled junkie. In case you haven't guessed, and I imagine it's the same for any addict, the fix did not make me smile; we got these suckers:

 

 

 

 

The lighting is a little different but the story is the same. The final test was lighter than the previous one. What the crappity crap does that mean? Can you get pregnant, a smidgen more pregnant and then less pregnant again? Since that fateful evening there have been two more tests and they don't seem to be progressing in the way any IVF survivor would be proud of. 

 



 

 

 

I'm not an expert, not in anyone's book, but several hours of scouring the Internet makes me believe that something isn't quite right here. Tests shouldn't fade in and out, and by 11pd5dt, or sixteen days past ovulation if you prefer, the test line should be jumping right out of that oval window; it shouldn't pale into insignificance in comparison to the control line.

 

 

I am trying to remain hopeful, optimistic and bright. I mean, I've got two lines on a test so why am I even complaining? How ridiculous that I am not shouting "yay! yay! yay!" but instead I am whimpering over relative densities.

 

 

Maybe it's all okay. Maybe my embryos are just slow starters. Who knows? I heard on the pregnancy grapevine that sometimes test lines can be stubborn and refuse to pop out as quickly as you'd wish.

 

 

Tomorrow is my official test day and I will, once again, be peeing on one of those little devils but this time I can actually tell my clinic I have done so. I will also have to admit that I have been testing for some time now and that I am going berserk. I have no idea what they will say or do about my woes. Under normal circumstances - I think we have established these aren't normal circumstances - the lovely receptionist would book me an appointment for my seven week scan but, holy cow, I can't wait three more agonising weeks.

 

 

When I wake tomorrow, assuming I sleep at all tonight, I will also call my GP and beg her to do sequential blood pregnancy tests (betas) to see if the pregnancy hormone is doubling normally. My GP's practice is terrifyingly tight-fisted. The doctors there are so mean they point blank refuse to write a prescription for more than four weeks' worth of medication at a time, even if you need the meds permanently. If they cast me aside when I fall on my knees and cry for help, which is certainly possible, I am going to resort to begging the lovely doctors who took care of my first pregnancy to save me from despair. They made the foolish mistake of writing us a kind letter to let us know that nothing would be too much trouble if I ever got pregnant again.

 

 

One more thing, just before I sign off and while I have your attention: I am developing a constant pain on my right side just under my bikini line. Anyone know if that's not something to go a little bit mental about?

 

 

If you do have any answers, advice or any knowledge at all, please share. There's a handy comment box below to write out all your thoughts.

 





Nine

Nine. That's how many eggs we have. For those who are excited by numbers I can tell you that nine is two more than seven. As I am still in a drug induced haze, this won't be an overly flowery or descriptive post, I  don't want to scare you all off by going all Dali on you.

If I wasn't so addled I might tell you about the charming hotel we found just behind Baker Street or how staying in London the night before added an flavour of holiday excitement. I would mention the lovely Spanish receptionist who checked us in and my attempts to impress her with my rusty Spanish. I am certain that I would write that she was still on duty when we checked out and that she was too sweet when she told us she thought we were a very kind couple and much nicer than her average guests. I am pretty sure that, if I wasn't lazing in front of trash telly, you would hear about how smoothly everything flowed at the clinic; the kind elderly anaesthetist who explained how he got real joy from working within in NHS; the friendly embryologist who detailed how he uses Eeva and when it can be helpful. I would tell you about the simple lunch we had in a cafe on the way home but, most of all, I would shout out that I am so happy, overjoyed, excited and thrilled. Happy we got this far, overjoyed that we got nine not seven, excited that tomorrow I will know if we have created new beings and thrilled that we are one step closer to parenthood.

Counting my chickens

"You can get dressed, come through and we'll discuss the findings."
 
Once those words are spoken I exhale and wonder why my doctor always says "the findings". Am I his lab rat? It's just so, umm, experimental, I suppose. I brood over it as I hop down onto the lino flooring. Leaning forward I separate the jumble of clothes left dumped on the metal chair, promising myself that next time I'll fold. The phrase flips over and over in my mind; I decide that I am okay with it. At least, I muse, it sounds as though he is taking this baby making extremely seriously. Pulling my jeans over my cold knees I try to imagine what I am going to hear. My mind flips back to a few minutes earlier, I think of the click-click-clicking of the button as Mr T flipped through the dark spaces that represent my follicles. Just moments earlier, I was staring hard at black follicular spots on the screen, my neck ached from the strain as I tried to count them all. But, as always, the doctor was too fast for me to memorise the numbers that flashed past or to note all the little white lines that marked the spots. Click, click, click, click, click and we were done.


I close the examination room door behind me, attempt a confident smile and place myself on the seat opposite the doctor. Clattering from his keyboard fills the tiny room as he inputs the findings from my ovaries into an electronic file. I breathe slowly, notice the expensive watch skimmed by an expensive shirt and use the spare seconds to silently speculate about what car he might drive. I am just deciding on Mercedes when my train of thought is broken by his eyes flicking from the screen and directly toward me; my mind whispers "stay calm, look confident, relax". I wonder why I so desperately feel the need to maintain my composure in front of this man. He starts to speak and I nod mechanically.


"Your current cycle is quite different from your last."

I continue nodding, "Oh."

"Your last cycle was very good, you had plenty of follicles and we retrieved 16 eggs."

I'm still nodding and force a smile, "Oh."

I wonder if I am nodding too much, shift my position in the chair and brace myself for bad news.

"This time you have 7, maybe 9, follicles and we would expect to get approximately 7 eggs."

I am not nodding anymore, "Oh."

I blink through his explanation that every cycle is unique, that it doesn't mean there is anything wrong with me and that if we did another cycle it may all be wonderful again.

My mind screams: Another cycle, doctor?


Mr T continues to rattle off the plan from here on in: one more day of stimulating my ovaries, two more days of suppressing the egg release and then, finally, the trigger. Yup, we are at the big one. The trigger shot will help the few eggs to mature and get ready for collection on Friday. Yes, on Friday!


As my ovaries no longer seem to be enjoying the IVF game, the considerable meds I bought from the dodgy perfectly respectable Internet pharmacy were not nearly enough. Mr T takes me down to the nurses' station and arranges for more drugs to be sold. I make a mental note that I will have some updating to do on my IVF cost tally.  


I thank every one in the clinic, including the receptionist and the doorman from the apartments opposite, at least ten times each and head back to the underground station in the rain, hoping for a miracle on Friday.

Uncovering revolutions in IVF treatment

Firstly, I want to say thank you to all the people who commented on my previous post regarding the extra treatments my IVF clinic offers. There was some confusion between Google+ and me; unfortunately Google+ responded to my attempts to understand it by removing most of the comments from my blog. So if you need to know where your comment went, you'll have to ask Google because I'm not exactly sure. On the upside, I think I have managed to stop restricting my comments to Google+ only. Thankfully, all your lovely comments are still stored in my account but I have no idea how to link them back to my blog, sorry. I did read them all and they were very helpful; I appreciate that people made the effort to respond to my request for advice.


Okay, back to my normal blogging self:


The days following my fertility specialist announcing that I could improve my chances of achieving pregnancy by intently studying the embryos and/or by gluing them to my uterus, I was a little confused. I asked for your advice and you didn't disappoint, thank you. I was advised to find out more about the procedures before I committed, so that's exactly what I did.



Currently, there are two companies that are offering systems in the UK that analyse the earliest characteristics of developing embryos: Embryoscope and Early embryo viability assessment (Eeva); both technologies monitor early cell division events using time-lapse imaging.


Time-lapse imaging of embryos was first developed in the mid-1990s. Initially it was used as a tool to study embryo movement and development. In those early days, scientists hooked up videocassette recorders to culture incubators and captured the exact sequence of events after sperm met egg. As the research advanced, scientists investigated how early cell division characteristics, captured by time-lapse imaging, could predict the embryos destiny. After beavering away in their laboratories for many days, possibly months, the scientists made a breakthrough discovery: the timing of the first developmental events after fertilisation correlated well with blastocyst formation. Embryos whose fate it was to develop into beautiful blastocysts had a very defined schedule for each of the critical mitosis events. Building on these early observations, investigators have developed software systems, which incorporate fancy mathematical algorithms, that accurately predict which embryos will arrest and which will survive. Amazing, right?

Not only it is now possible to predict blastocyst formation but studies have shown that, using these advancements, embryos likely to yield pregnancies can be identified prior to transfer. Remarkably, transferring embryos that were rated as high, using an imaging system, led to a 66% pregnancy rate. In contrast, when embryos were transferred that were rated low only 8% of women became pregnant.  


For me, the most fascinating element of these new technologies is the apparent correlation between embryos that are predicted to be poor and the presence of chromosomal abnormalities. Two studies (here and here) have demonstrated the cell cycle and fragmentation patterns, identified using time-lapse imaging, are diagnostic of faulty chromosomes.


The results from these studies sound wonderful and they are certainly extremely promising; it would be difficult to deny that this really is astonishing science time. However, no one has published any studies or clinical trials which demonstrate these imaging systems are better than an embryologist at predicting which embryos will make it to blast; my clinic is super confident that their embryologists are excellent at choosing embryos for transfer. The truth is that there have been absolutely no clinical trials published assessing whether these technologies increase pregnancy rates when compared with current methods.  



A review of the use of time-lapse imaging for embryo assessment, published in March this year, concluded "before time-lapse markers are to be implemented in the clinic, additional clinical validation of their safety and efficacy and their measurement/quantification technologies is urgently required".



The FDA also seems to be under the impression that treatments should demonstrate efficacy prior to routine implementation and, not surprisingly, has decided to wait to evaluate clinical trial data before licensing the technology in the United States.


So why are these systems already in use in European clinics? I asked my fertility specialist that very question; he argued that couples should have access to all opportunities to increase their chances of success. I am unconvinced that, usually pretty desperate, couples should be expected to pay for unproven treatments. Sure, if the clinic wants to boost their success rates and offer it to their patients for free then I'm all for it. Now that I am there, I know that, even though the science is shaky, I want to do everything, even irrational things, to increase my chance of pregnancy.

I think Dr Sue Avery, from the British Fertility Society, sums it up perfectly (play the clip to find out what she says):




Source

I guess I am struggling with the ethics of it all. I am also worried that these scenarios will become more common in the British health system as an increasing number of services are privatised. Good ethical policies in medicine and science are so important and I fear that sometimes the desire for money triumphs over reason. This weekend an argument over the patent granted for this technology has erupted in a British newspaper. The United States Patent Office has recently granted a patent whose claims include the monitoring of embryo division. How can that be? Is it ever okay to patent the measurement of naturally occurring biological processes? I am extremely keen on the idea that innovation and invention is protected by patents, and I would applaud a patent that covered the use of the mathematical algorithms or the imaging software, but the processes that underlie life itself? Should they really be able to be covered by patents?

I don't know the answer. Maybe you have some ideas and opinions about what is and isn't acceptable? If so, do share.


My doctor also suggested we try EmbryoGlue and I have done some research on that too. However, this post is getting quite long now so I am signing off and will cover EmbryoGlue in a separate post.


Side note: I did read the patent and I am not sure that the claims are as extreme as the newspaper article would have us believe.

Mo' money, mo' problems

Last year, when I took my slightly battered car for its annual service, the mechanic cheerfully informed me that I needed four new tyres. He kindly explained that standard tyres would be acceptable but extra special non-slip tyres would be so much better. He thought that regular tyres were okay, of course, but, if it was his car, the better tyres would be fitted without a doubt. Towards the end of our discussion, just as I was leaning towards the fancy tyres, he dropped in that the better tyres also had a mightily spectacular price. Hum, decision made, I was pretty sure my little car will be alright with the basic tyres. 

Haven't we all enjoyed similar conversations with garages, or car salesmen, or even kitchen fitters? However, I was knocked-off-my-feet surprised when I had the same experience with my IVF clinic. Yes, I am not joking, it really did happen.


Yesterday I went for scan number two of my current IVF cycle. There were the usual dilemmas: Is it acceptable to make small talk whilst the doctor is lubing up a condom? Can I shriek "Youch" when he presses too hard on my left ovary? Is it okay to ask why my doctor decided on a career where he spends most of the time looking into ladies' private parts? You know, the usual stuff. But on this occasion, during our familiar wind down pleasantries, Mr T looked down at his hands and started to mumble. There was clearly something on his very thoughtful mind. Huh, he's got something awkward to say, I thought, wonder what it is? I hope I haven't got a large growth hiding in my uterus. The doctor shuffled in his chair, frantically tapped away at his keyboard and finally brought up the subject of two "optional" treatments. What?! There's more stuff they can do to me? Well, as it transpired, not me exactly.


The first addition up for discussion was Early Embryo Viability Assessment (Eeva). If you think it sounds fancy, that's because it seriously is. Eeva is a method of continuously monitoring embryos during their first moments and days of development. The very scientific theory goes that by scrupulously watching their every move and division you can tell which embryos are the good ones. And, based on a complicated mathematical algorithm the embryologist can, potentially, choose that elusive embryo capable of yielding a golden pregnancy. Good, huh?




Source


The second super-dooper IVF improvement is called EmbryoGlue. Yes, the marketing bods really have named the "optional" treatment EmbryoGlue. Who is going to turn down the opportunity to glue their embryo to their uterus? The science is a bit, but not much, more complicated than just gluing one thing to another; it involves adhesion molecules and carbohydrates but, in a biological sense, sticking things together is exactly what it does. A-ma-zing! Just look at the title of their movie clip. Who wouldn't want that?



Source


What's the catch? Well, there really isn't a lot of evidence that either of these things will definitely make me a pregnant lady. And, not surprisingly, they come with some pretty yikes-inducing price tags.
 

As I listened to Mr T enthusing over the benefits of these two IVF advancements, I couldn't hide my scepticism; I was the same with the mechanic. As my eyes grew wider and wider, my lovely fertility specialist finally cracked and said "Well, it certainly won't hurt". Losing control of myself for a moment, I let out an involuntary snort - always attractive - and Mr T conceded that it would most definitely hurt my pocket.


So it has come to this. I am forced to make decisions about whether I take the gamble and pay the money for experimental treatments that might - Mr T says probably - improve my chance of a pregnancy. I can't help feeling that this shouldn't be my decision. Surely this is either the best treatment, in which case sign me up, or no-one really knows, in which case, do the bloody trials.


The cost for both treatments would be £1200 (approximately $1800 USD) and, if I choose both, could increase my pregnancy rate from 50% up to a staggering 80% (possibly).


If I turn it down and I don't get pregnant will I beat myself up and think I should have done more, spent more, tried harder? Of course, the lovely fertility specialist was very careful to say my current plan, without the bells and whistles, is perfectly good - nothing wrong with it - but, in his opinion, the extras would make it better.


I don't know, I really don't. Any advice? What would you do?

Back on the big dipper

Why do people voluntarily ride roller coasters? Perhaps if the aliens land tomorrow they will think that, if they base their assessment on the roller coaster riding alone, the people who inhabit this planet are bonkers. The creatures from Mars will see that, before the earthlings climb into the buckets, they are trembling and, once seated, they will scream, nausea will rise from their guts and, if it's a good one, even cry. However, once it's over, you will hear the riders say how thrilling it was, oh it was such an adventure, they'll say; get right back in line and hop on again for one more go. In short, the exciting, thrilling, exhilarating, wonderful feelings outweigh the fear, vomit and scream-inducing gut-wrenching stuff. Maybe that is why couples keep on putting themselves through one IVF cycle after another: the hope that, one day, after all the rain they'll get a turn at dancing in the sunshine.


This week I had the first scan of my current, it's my third if your counting, IVF cycle. I tried to remember how many scans I have had throughout my infertility journey  but I can't, there have been just too many. After the first scan of my last frozen cycle I wrote down my thoughts on the scan process and, lucky reader, you can read all about it below:

 
"On the train back home from my clinic I couldn’t help thinking about how odd these scan sessions are. Maybe it is just me but they are weird, aren’t they? I find it all so awkward and slightly hysterical at the same time. I spend a good ten minutes in the morning checking everything downstairs looks okay, like anyone cares, and the thought that it isn’t pops into my head many times during the day. Then, once I get to the clinic, I spend several moments debating whether it should be socks on or socks off, wondering if it matters, and trying to remember if my nail varnish would be suitable if I do dare to go socks off. Finally, I make a socks on decision, clamber onto the chair, or maybe it’s a bed – I am not sure what it is – and I attempt to maintain some semblance of dignity whilst desperately trying to balance in the stirrups. Once I think I’m safely in, I have to call out “I’m ready” at which point I panic wildly, think Mr T won’t hear me so call out two more times with increasing volume and desperation. The whole humiliating process culminates with, what can only be described as, an eye-wateringly large dildo like probe which, to add insult to injury, gets lubricated and covered with a condom! Then the lights go down, I half expect Barry White to start playing, and we get to spend several minutes examining my inadequate innards. Like I say – odd!"


I had the exact same feelings again this week - nothing changes. Except this time, instead of excited anticipation, I am nervous and a little bit scared. The scan went well, I have 8 resting follicles (that's okay, apparently) and none of my internal organs had left the building - I wouldn't blame them if they had, I think they've had enough. But this time I have prior knowledge of what lies ahead; I know that IVF is hard and it makes me feel like this:

Oh before I forget, the financial round up:

1. IVF meds:    £1092
2. IVF cycle:   £3275
3. HEFA fee:    £75
4. Train fares: £28
   Total:       £4470

I am an IVF junkie

It turns out that having a text speak name, being very cheap and only existing on the Internet doesn't mean that you are an untrustworthy outfit run by a gang of Internet fraudsters, living off great piles of cash sent to you by desperate infertile couples. It also seems that my inability to get things done any quicker than your average snail, or get things done at all, hasn't brought our IVF cycle to a grinding halt. No idea what I'm talking about? Then see here. For the rest of you:

We have drugs and lots of them too. Look at them all. 

It is mind-boggling to think that in four weeks time, if everything goes according to plan, all those little beauties will be inside me - they shouldn't be in me all at once, some of them have better be metabolised or else I am one odd fish. Those drugs you see right there will, oh so hopefully, have made a baby or two or three or four or more. Yes, I know embryos aren't the same as babies but, please, work with me, I am writing out my dreams here. The great and good Mr T, our fertility specialist, seems to think he has got me all figured out this cycle. No need for guess work or buying our fertiltiy meds one syringe at a time. So, we've only gone and bought them all at once. Yikes! Oh Lord, I hope that doctor is worth the megabucks. In case you are wondering what the plan actually is, and it seems obvious to me that you must be, I have handily prepared a flowchart, not including scans which are randomly placed throughout:

In other news, my period kindly arrived. I apologise if you were still hanging on the edge of seat after my "could I be pregnant?" post. Hope can be a terrible thing. Maybe I should have cushioned the blow for you? Next time, although I'm hoping next time I will be screaming from the roof tops "I'm bloody pregnant!", I will gently sit you down, offer to make you a cup of tea and say "I have some bad news, you know that baby you wished I was making? I am afraid it's not going to be this month, dear". More importantly, the arrival means that I can take a trip to London tomorrow to see the magnificent Mr T in person. I get to spend some quality time with him and his magic stick (always enjoyable); then, assuming my uterus hasn't jumped ship when I wasn't paying attention, I will have the joy-inducing opportunity to hand over a ton of money.


For those who are financially minded, and so it reminds me to behave responsibly and not book a random weekend break, I will be tallying up the credit card bill as we go along. Here comes the first total:

   IVF meds: £1092
      Total: £1092

Down to the wire

We've all done it - left something until the last minute, that is. Most of the time it's the not so important things, like going to a party, but sometimes it's the big stuff, like, hmmm...I don't know, revising for a crucial exam or filing your tax return, maybe?


Have you ever decided that you really do have time for one last cup of coffee before you leave to meet a friend? Even though there is the niggling voice of doubt telling you that you probably don't. And, is the result of your terrible inertia, a fraught journey comprised of zooming down a motorway at top speed, performing an almost fatal balancing act between avoiding a fine for irresponsible driving and risking a meeting with an irate friend? Quite often it is difficult to establish which would be a worse fate, the friend or the fine. Or perhaps you have become proficient at performing the run-walk, I know you must have done it too, all the way from your house to the station, or bus stop, or meeting place.


Is it possible that you have found yourself happily explaining to friends that it was your plan, right from the outset, to buy your bikinis at the airport because, obviously, shopping with no changing rooms, only a few minutes to spare until your gate closes and carrying a heavy case is your idea of a fun afternoon? Anyway, you tell them, you have always wanted to hear your name echoing loudly throughout the departure lounge. When the sad truth is that no matter how much your partner begged you to pack the damn case, you continued to protest that 30 minutes was ample time to pack, shave your legs, apply fake tan and find your passport. The upshot, along with the impromptu swimwear purchases, is invariably a grumpy taxi driver sitting on his horn right outside your front the door as you desperately attempt to cram a lone sandal, all the while fretting hysterically that people will notice that not one of your shoes has a partner, into a bulging suitcase. 

These things happen to us all, don't they?


A good friend of mine during my university days suffered shockingly badly from the same affliction; no matter how hard she tried, she was completely powerless to study until the very last few moments before exams. The poor girl would sit on the steps outside the examination hall, with tears welling up in her eyes and with desperation etched across her face, open her folder for the first time in months and wail "but I just don't know anything". She, not surprisingly, failed her Chemistry degree but, you will be very pleased to know, did go on to become a very good nurse.


Sometimes though, you amaze yourself and you only go and bloody pull it off. The sensation of success feels great and the adrenaline inducing rushing around all seems worth it. Although, once again, you promise yourself you will never procrastinate again.


By now you must be wondering what all this has to do with infertility or IVF; I am taking a stab in the dark that this is why you have found yourself reading this blog. Unless, of course, being a passionate gardener, you typed "in my garden grow" into your search engine and landed up here by mistake. In which case, I am truly sorry - I really didn't think it through when I was choosing the name for this blog and, if I were to do it again, it would have the words "pregnancy" or "infertility" or perhaps even "IVF" in the title - but, regardless of how you got here, please feel free to stick around. I am afraid I can't help you with your tulips but, you never know, you could just learn a thing or two. Oh dear, there I go again, ramble, ramble, ramble. The point is, if I can ever get myself there, that I have found myself almost leaving something very important too late.


Several weeks ago I nervously fired off a cheeky email to Mr T, our fertility specialist, asking him to write us a private prescription for the medications that we require for our upcoming IVF cycle. He had previously hinted that he could be persuaded to do this for us, which was very helpful because, as you can imagine, clinics situated opposite Reagent's Park in London don't tend to have the lowest pharmacy prices.  However, another doctor at the clinic, who is definitely not my favourite, explained, when asked to write a prescription before our first cycle, that it really wasn't the done thing and we should buy our meds directly from the clinic. So, as you can probably guess, I felt quite brave and just a bit proud of myself for securing the private prescription. What I should have done next, but clearly didn't, was jump online locate a reasonably priced pharmacy not too far away and place an order. What I actually did was deposit the prescription on our coffee table, so I could walk past it every morning and mutter "I must deal with that this evening" and, occasionally, mention to my husband that the script was there. I can't say it was a total surprise, although my reaction may have begged to differ, when I realised with only a few days until kick-off that the drugs were still not ordered, the pharmacy still not found and the little white slip was still lying in the exact same spot on the coffee table.


The fear that we would miss the deadline altogether was enough to spur us into action; when I say us, I mean my husband. He hopped on the web found an online pharmacy and merrily ordered away. Although, I do wish the pharmacy  he chose didn't have a name that was spelt in text speak - I hate to admit it but that does make me bloody terrified. So, if we haven't just sent our hard borrowed money to the Cayman Island, we should have some lovely, and potentially rage inducing, drugs turning up on Tuesday. I am really hoping they don't get delayed and/or that my period doesn't surprise me and turn up before Monday, because if either of those things happen, we're screwed.


Now that we have got ourselves together, and, yes, I do mean my husband when I say we, the following drugs are, hopefully, winging there way to us:

• One drug to make my eggs grow plentiful and mature - that one is called Gonal-F

• Another one to stop my little, or hopefully big but not too big, eggs from popping out of my ovaries prematurely - that one is called Certrotide.

• A drug to release the eggs from my ovaries when the moment is just right - that little beauty is the trigger shot and is called Ovritrelle.

• And finally, a drug to keep my uterus cushiony plump for a little embryo to bury into my uterine lining - this one is called Cylogest but you might know it better as progesterone.

We are now £1100 deeper in debt, I would love to say we that were are just a bit poorer but this is, without any doubt, unless we win the lottery, going to be a credit card baby. You might think that's irresponsible, and I do too, but, in case you haven't got it already, I'm desperate for a baby here. On the upside, we have saved ourselves £400, that is assuming that we have ordered from a reputable company, the text speak name was just an unfortunate marketing blunder, and we haven't just sent our money to pay for an extra gold tap in a luxury mansion belonging to an internet fraud kingpin.



Let's just hope my dilly-dallying hasn't really buggered it up this time and, yes, I promise, I promise, I promise that next time I won't dawdle and I will jump straight onward to my next task. What's that? Cup of tea, you say? But I really must get on. Oh dear, you've twisted my arm, just a quick one though.

Smoking and IVF: it's just plain old bad news

As I was driving home from work on New Year's Eve in 2007 I smoked my last cigarette; I remember it well. The smell and taste of those last few drags can still easily be recalled from my memory. My decision to quit was fuelled by my concern that an increasing proportion of my pay check was flowing into the pockets of the tobacco giants and, of course, the fear of cancer. What never crossed my young mind, even as the last stump burned to the end, was the possibility that my favourite bad habit was damaging my fertility. I am not saying that my choice to spend my youth puffing away has left me infertile, I don't know whether anyone could tell me if that is true. However, a review of recent scientific literature performed in 2008, and another published in 2011, both concluded that cigarette smoking compromises every aspect of the reproductive system. Whilst the results are clearly not wonderful news for a smoking lady hoping to make a baby au naturel, they don't really tell you whether smoking will ruin your eye-wateringly expensive and hope-laden IVF cycle. 

Yes, you guessed it, we are here again, taking another step forward in the research journey that is Operation Big Belly. And, as you may already know, we have so far investigated the possibility that food, alcohol and caffeine could reduce your chances of an IVF baby. Now that we are getting started I should remind you that the ground rules can be found here.


So, even though the clues seem to be screaming at us "Of course smoking is bloody terrible, you fools", let's ask the question anyway, we might be pleasantly surprised: will smoking screw up your chances of a successful IVF cycle? One health authority in Scotland is so sure that cigarettes are completely atrocious that it has banned couples who smoke from having IVF treatment on the NHS (see here). Now, what the Scottish choose to do might be extremely fascinating (if I were cynical I would say their decision was swayed a teeny weeny bit by the desire to spend less of their health budget on the not-so-election-busting infertile couples), but what can science tell us about smoking and IVF? 


This time at least there is a respectable body of data to get yourself excited about. As far back in time as 1996, there was a healthy level of research interest in IVF and smoking. The first review of published studies that investigated the role of smoking in IVF success, found seven papers worth examining and revealed that, although there was variability between the studies, the conception rate was lower and the miscarriage rate higher in women who smoked.


A year later, a research group from Austria published the results of a meta-analysis that investigated the effects of smoking on IVF results. The data review comprised of eight studies, including the authors own, and analysed the outcomes of 2314 IVF treatments. The studies reviewed yielded conflicting results and with some indicating that smoking didn't impact the IVF success rate. However, when all the data were taken together, the meta-analysis revealed that non-smokers were significantly more likely to get pregnant during their first cycle than smokers, and that smokers require twice as many attempts to achieve pregnancy.


If you step forward just a few years more, this time to 2005, you will reach a pretty thorough review conducted by Hilary Klonoff-Cohen (we met her before here). This lovely lady has gone to the trouble of reviewing 22 articles, including the studies mentioned above, and the data, as with the previous reviews, was somewhat conflicting. She did not conduct a meta-analysis, so it is not possible to say if the studies which demonstrated no effect on IVF success rates for smokers would have remained significant when the body of evidence was examined as a whole. However, she did conclude that "despite the variations between the studies, there was compelling evidence that smoking had a negative influence on IVF outcome".

If you manage to pick yourself up from those revelations and roll forward a few years, you will find that you have landed at the feet of a second meta-analysis conducted in 2009. On this occasion, a collaboration from the UK (yay!) analysed data from 21 studies to investigate the impact of smoking on IVF outcomes. The investigators found that smokers had a lower chance of pregnancy, a higher risk of miscarriage and ectopic pregnancy, and a lower live birth rate. Non-smokers were found to be twice as likely to get pregnant and have a baby at the end of it all. Not only that but the analysis went deeper, smoking was shown to be bad for every step of the IVF process; smokers required greater stimulation, had fewer eggs, lower fertilisation rates, and a higher chance of implantation failure. The authors concluded their paper by stating "There is particularly overwhelming evidence for a decreased clinical pregnancy rate amongst smokers, in addition to the strong implication of a negative effect on live birth rate, miscarriage rate, ectopic pregnancy rate and fertilisation rate". Phew! They weren't messing about, were they?
 

I could find no more reviews or meta-analysis studies since the one performed in 2009, described above. However, there have been more experimental studies that have investigated the relationship between smoking and IVF success. Since 2005, I realise I have gone a little further back than the last meta-analysis, researches have discovered that smoking is associated with lower delivery rates and higher miscarriage rates, decreased uterine receptivity and increased numbers of multiples, a lower number of fertilised eggs and correspondingly lower pregnancy rates, reduced ovarian reserve and, once again, correspondingly lower pregnancy rates, poorer ovarian responses to stimulation and impaired embryo development.


Well, if that wasn't quite enough to put you off your cigarettes for good then maybe the final study will convince you. In 2011, a research group based in Israel discovered that, when women smoked, even if the doctor put great quality embryos back into the uterus, the pregnancy rate was lower for smokers than non-smokers. Oh dear, even an excellent embryo can't help you!


In the interest of fairness, I should point out that, since 2005, there had been one, yup just one, study that found no difference between smoking and non-smoking groups of women undergoing IVF treatment.


So there you have it. If you are planning to do IVF and you enjoy a smoke, you might want to think about enjoying it a little less often or, preferably, not indulging at all.


Writing this post has made me a little sad; I wish I could go back and plead with my younger self not to pick up that first cigarette. And, yes, there was an adolescent boy, who I was attempting to impress, connected to the decision to take my first puff. But I doubt that young lady would have listened to a word of it. Babies seemed so far away and she comes from one of the most fertile families on the planet: three brothers, three sisters and thirteen nieces and nephews. I know you shouldn't regret the past, and on many occasions smoking gave me real joy, but, as the great Cher once said, if I could turn back time.......

The first step

Little Pill, as you sit on the table in front of me, I look at you and wonder. I examine your size, your shape, your texture. I marvel at your neatness; how compact you seem lying here before me. I take you in my hand and let you sit there for a while. I want to know more about who you are: what might you do to me? So I search; I am rewarded with new knowledge about your structure, your function and I laugh at your unpronounceable name.


Little Pill, if I swallow, will I become Alice? Will I fall down the rabbit hole? Will you come with me through Wonderland? And, Little Pill, is there a chance I could awaken to a brilliant new reality? Can you make my dreams come true? Or, Little Pill, will I be trapped here, still in this never-ending infertile nightmare?


So Little Pill, as you can see, I am nervous and fearful. We have been here before, you and I. Can I take this leap of faith? If the worst comes to pass, will my heart be strong enough to bear the pain? My soul longs for what's on offer: for the promise of a different life. But I have seen the underworld; I have taken a walk through Hades. I look at you once more, Little Pill. You sit still, motionless, ready. 

Can coffee mess with your IVF cycle?

Do you know what helps bees to remember which plants they would like to visit again? Yes, that's right, the answer is caffeine. According to scientists, who are definitely some of my favourite people, bees like to return to flowers which produce caffeine containing nectar. If you think that's an interesting fact, you can read all about it here, I suspect you are going to enjoy this blog post. Although caffeine is a relatively simple molecule (see it's structure below), it does have some pretty impressive properties and there is considerable debate about the impact of caffeine on pregnancy. The World Health Organisation recommends that pregnant women not exceed a daily caffeine intake of 200-300 mg. However, in constrast, a recent Cochrane Review concluded that there was insufficient evidence to determine whether restricting caffeine consumption improves pregnancy outcomes (see here). But I am sure you're not so interested in bees or pregnant ladies; what you really want to know is: will caffeine make your IVF cycle less likely to succeed? Well, you're in good company because so do I.

Let's go together now and take the third step on our research journey or, as I have affectionately called it, Operation Big Belly. As you may remember, we looked at the evidence that diet can impact an IVF cycle here, whether a drink or two will reduce your chances of having an IVF baby here, and, as usual, just a reminder that the ground rules can be found here.


So then, caffeine and IVF. Well, once again, I have spent a considerable amount of time searching on-line databases to provide you with the all the latest information. And, as usual, I have found very little data on the impact of lifestyle on IVF success. This time I was looking specifically for caffeine data and, frustratingly, I haven't found a larger data set than I dug up for the effect of diet or alcohol on IVF cycles. In fact, I have managed to only scrape together two studies. Still, two studies are better that none and it does give us something to get our teeth into.


The earliest study, led by Hillary Klonoff-Cohen, was conducted between 1993 and 1998 in Southern California. During the clinical trial, 221 couples, undergoing IVF or gamete intra-fallopian transfer (GIFT), were recruited to determine if there was a link between caffeine consumption and IVF outcome. The authors reported that, for women consuming caffeine from coffee, tea, soft drinks, cocoa drinks, or chocolate, the risk of miscarriage, not becoming pregnant and not achieving a live birth was significantly increased.  There was, however, much better news for the boys: male caffeine consumption did not negatively affect sperm, embryo transfer rates, the chance of getting pregnant or pregnancy outcomes. But, and this is quite a big but, men's caffeine intake did correlate well with an increase in the number of multiples. So if you don't want to have twins......


You might not like the findings from that first study, and who could blame you, neither do I. But, let's remember, it is a very small study and only a lone study. Perhaps more recent data will give us better news.


The second study we are going to take a look at was conducted in the slightly more exotic location of Saudi Arabia. This time 619 women took part and all of them went through their first IVF cycle between 2002 and 2003. Unlike the majority of the studies we have examined, this study has something special; the lifestyle results are not only based on questionnaires completed by the patients but, in addition, the actual concentration of caffeine was measured in blood and, more excitingly, in follicular fluid. The study authors concluded that they could find no association between coffee and tea consumption, or the level of caffeine in serum, and pregnancy rates (yay, some good news at last). However, they did find a negative correlation, albeit a weak one, between tea drinking and the number of good embryos - the more tea you drink the fewer the good embryos. And there was also a link between high caffeine consumption and miscarriage. Sadly, the study didn't continue to assess the women for the next nine months, so we can't tell if caffeine would have impacted the live birth rate in those women.


So, let's sum up, we have one study that shows caffeine does negatively effect IVF cycles and one that indicates it probably doesn't. Oh, if only we had more data. Hang on, what's this? Ah, I am about to break Operation Big Belly's ground rules; I have found one more relevant study that was reported at a scientific meeting but has not been formally published. However, the meeting abstract and the subsequent press release are available on-line.


The study was a large one - this time we're in Denmark - and was presented last year to the European Society of Human Reproduction and Embryology (ESHRE). The researchers followed nearly 4000 women before and after their IVF cycles to find out if drinking coffee would result in lower pregnancy or live birth rates. Once all the data were collected, the investigators found that having up to four cups of coffee per day didn't really make any difference to the IVF outcome (yay, again), but having five or more coffees reduced the pregnancy rate by a whopping 50 percent and the live birth rate by, an equally staggering, 40 percent. Oh.


It seems that, at the moment with a very limited data set, heavy coffee consumption can reduce your chances of taking home a baby after IVF. Although, of course, it is possible that future larger studies, which I hope that some smart research group is working on right now, will show that caffeine doesn't really cause less women to become pregnant or babies to be born.


So, that's caffeine dealt with. What's coming up next? Well, in case you haven't figured it out already, the first phase of Operation Big Belly is dealing with consumption: we have looked at food, alcohol and caffeine.  As I am not planning to tackle illegal drugs, the only thing left to look at is cigarette smoking. Ahhh, the evil weed. Until next time....

WTF!?! & a new plan

It was Tuesday and, unlike most Tuesdays, it was a very important day. My husband and I worked together to make sure that, with a little luck, there would be no hiccups. Hell, having spent some time finding a model with great reviews, we even bought a brand new telephone. We felt that a decent phone was high on our priority list. After all, we did want to be certain that, when it filled our living room, the sound of the doctor's voice would be crystal clear. We desperately hoped not to miss a single detail, no matter how small, as it could be the all important clue that we were searching for. My husband had the day off and stayed at home and I, as I usually did, woke up, got washed, dressed, ate my cereal and went out to the office. Work was the same as work always was, except, on this particular Tuesday, I took care to ensure everything would be finished on time. I was hopeful, and nervous too, but mainly hopeful.

In the afternoon, as I left the office, the sun was shining. It wasn't hazy, but instead, it had a brilliant radiance which illuminated the white clouds hanging against the sheer blue sky. I crossed the car park and my nerves started to jangle. Even though I am not superstitious, my heart still believes that bright sunny days bring good news, whilst bad things happen on cold dismal days. Oh dear, look at that, I've lost my thread again and got distracted by being all wordy. So, back to it, where was I? Ah, yes, it was Tuesday and the sun was shining. I had left work with time to spare but, as I drove past the same hospital I pass every day, the traffic slowed to a crawl and, with only five minutes until appointment time, I fielded a frantic "where are you?" call from my husband. After what felt like an age, the cars moved, I hurtled towards home and flung myself through the front door with 30 seconds to spare. Phew, I made it. 

Then, as I plonked myself down on the sofa, I grappled with the new technology, dialled the number and waited for Mr T, our fertility specialist, to speak. And so began our first ever Why-The-Fail appointment.

 
Soon enough, the familiar Greek tones of Mr T came down the line and the conversation, after a few pleasantries, went like this: 


Mr T: Your recent failed frozen embryo transfer was a very nice cycle.

Me: Oh, very nice?

Mr T: Yes. The embryos were of perfect quality and your uterine lining was fine.

Me: Oh, perfect quality?

Mr T: Yes. The transfer went well and there really weren't any concerns.

Me: Oh, anything else?

Mr T: No. You were just unlucky. It happens sometimes.

Me: Oh.

A million and one thoughts were whirring round and round in my head. I wanted to shout "If it was so perfect, then why didn't it work?" or "Can you please make sure my next perfect cycle doesn't fail?". I didn't shout, or say, or even whisper anything. He didn't have the answers I wanted and can't give me the guarantees I long for.


After giving us a few moments to digest the avalanche of information he had just thrown upon us, Mr T went over the plan for our next fresh IVF cycle. The entire call lasted, from hello all the way to goodbye, almost precisely, eight minutes.
 

So, once again, we've been hit with the unlucky stick - I do wish it would give us a rest for a while - but, very happily, we do have a new plan. Well, actually, it isn't a new plan at all. It is the very same plan as we had for our first IVF cycle. You know, the one that led to wonderful identical twin girls that didn't quite make it.